Managing Conditions Often Associated with Breastfeeding
Hypoglycemia in breastfed infants is a commonly cited concern among physicians
- Healthy full-term infants with normal feeding patterns have adaptions to prevent problematic hypoglycemia.
- Infants most at risk are small or large for gestational age, late preterm, or born to diabetic mothers
- Reducing the occurrence of hypoglycemia can be facilitated by
- Encouraging skin-to-skin care
- Improving milk intake by early and frequent breastfeeding
- AAP recommends screening for hypoglycemia in symptomatic or at-risk infants only.
- Routine supplementation of healthy, asymptomatic breastfed infants to prevent hypoglycemia is not indicated.
- Manage mild hypoglycemia with prompt feeding
- Newborns who are not feeding well are at risk of breastfeeding jaundice, sometimes called suboptimal intake jaundice
Usually occurs in the first week of life
- low milk intake, relative dehydration, delayed passage of bilirubin-rich meconium, and an active enterohepatic circulation of bile may lead elevated bilirubin.
- Infants with increased rates of bilirubin production caused by hemolytic processes (eg, ABO incompatibility, glucose-6-phosphate dehydrogenase [G6PD] deficiency), bruising, or ingested maternal blood may be at increased risk
- infants with immaturities in conjugating bilirubin (typically seen in Asian or late preterm infants or those with Gilbert syndrome) may also have jaundice in the early days after birth
- Prevention of breastfeeding jaundice is key.
- Encourage exclusive and frequent breastfeeding at least 8 to 12 times per day, avoid water or unnecessary formula supplements, and teach mothers proper latch technique to help prevent poor intake, excessive weight loss, and jaundice
- There is never a need to interrupt breastfeeding
- an appropriate response is to optimize intake by improving milk transfer, by having the mother express milk to increase milk intake, or with the judicious use of pasteurized donor milk or formula supplements for infants with significant hyperbilirubinemia
- supplementation is not routinely indicated.
Breast Milk Jaundice
Jaundice that occurs in healthy thriving breastfed infants usually beyond the 2nd week of life is known as breast milk jaundice (BMJ).
- In BMJ, serum unconjugated bilirubin remains elevated, and a few infants may have elevated concentrations for as long as 6 to 12 weeks
- This elevation in serum bilirubin is a normal response to breastfeeding, and
other than the presence of jaundice, infants with BMJ seem healthy
- The cause of breast milk jaundice is unknown, but factors in human milk that increase the enterohepatic cycle of bilirubin or genetic variations that impair bilirubin hepatic conjugation may play a role.
Breastfeeding should be continued, and in most cases the parent or parents should be reassured.